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A few weeks ago I began a discussion about the quality of national healthcare (comparatively between nations) with a friend and I stopped because I realized I was not necessarily speaking from fact. My “certainty” was coming from hearsay, conjecture, personal skepticism partially created by mistrust, and sources that may (or may not) slant perspective to fit an agenda. I am confident that my friend's certainty may be influenced by similar factors, though instead of mistrust and skepticism, he revealed trust and confidence; (in my opinion, naively so), but I was suddenly uncertain so I told him that for me to continue the conversation I would need to gather some facts.

I began by simply searching for “quality” of healthcare and found some consistency in that Canada and the U.S. (the specific countries that initiated our discussion), are not typically in the top 10, and on one ranking from the World Health Organization not even in the top 25; (Canada is #30 and the U.S. is #37). But I also found that these rankings include a complexity of criteria such as life expectancies, mortality rates, cost per capita, cost as a percentage of GDP, and other (some unfamiliar, some vague and subjective) measurements such as years of potential life lost, patient rights, waiting times, services provided, quality, access, administrative organization and safety. Additionally I found that many of the results of these measurements may not reflect quality of healthcare as much as they reflect quality of life. And I found that the nature and character of the National patient in each country also impacts the results. More than in any other country, (except perhaps China), it appears that the typical U.S. patient is a demanding, bullying, pretentious, skeptical, argumentative crybaby who must have their way and plans to live forever. This drives up cost by forcing the system (already afraid of litigation) to order too many expensive tests and perform too many expensive procedures, and it (likely) adds to the stress of the individual thus possibly helping to explain our nation's recent reversal in a decades-long upward trend for life expectancy.

So where do I find the facts?

Or perhaps more importantly, what specific facts am I looking for?

I just blew up cost as an objective standard because the United States as the most (or one of the most) expensive countries, (depending upon the source), may be more reflective of our individual character than it is of the quality of our healthcare. And though an anecdotal case could be made, (as it was in a recent article from CBS News reporting on a caravan traveling to Canada for $30 insulin instead of staying at home and paying $340), I am afraid if I argued that case I would be overwhelmed by a plethora of other confirmation bias examples.

The best I can make of many other criteria including access and efficiency, from what little research I have done, is that much like cost, it becomes a matter of personal experience influencing perspective, and in its aggregate (between comparable countries) is probably close to a wash anyway.

The one outlier to “factors that are likely a wash” between the U.S. and Canada is simplicity or ease of use. If that were the yardstick, by all accounts the U.S. would come out on the short end. But one could argue, (and I suspect that most of us would agree), we would not mind going the greater lengths to add years; and when we do, (driving up cost in the process), we truly believe, as Americans, that we will get those years because we deserve those years; though again, the outcomes between the U.S. and Canada appear to be similar.

So do I go along with consensus algorithms and expert opinion and accept that there are many countries with better healthcare systems than both the United States and Canada with the small satisfaction that (as I originally claimed) Canada overall has the edge over the U.S.? Or do I stick to my guns and make up my own mind based on unfounded assumptions, childhood indoctrination and fake news, and continue to believe what I believe?

I suspect I am better off listening to the more moderate, reasonable, fact-based algorithms and experts, even if the results of their measurements do not reflect my perspective as impacted by personal experience and opinion. I also believe however that the more informed, realistic perspective of experts would be potentially more beneficial if we studied those countries found consistently in the top 5 or 10, and stopped arguing about middling countries like the U.S. and Canada. It is another example of why perhaps we would all be better off, on all fronts, if we paid closer attention to the experts.

Bottom Line for U.S. vs. Canada: because it is complex, cumbersome and difficult to navigate, and because I found more specific examples of higher cost here, I still believe that healthcare in the U.S. is of a lesser quality than that in Canada, though the gap is not as dramatic as I believed before my limited research.

So what am I going to say to my friend when I see him this weekend? I am probably going to cite the story on the insulin caravan and say, “see, I told you so.”

I read this week that children who see an individual being treated badly are much more likely to blame the recipient of the abuse than to consider the tormenter responsible. And this blame comes with no explanation or knowledge of why the individual is being treated badly; the children simply believe the individual deserves it. I am going to extrapolate from this research to a premise, knowing that my “leap” may be just that; but it feels right.

The Premise: Not only a strong majority of all of us but also a strong majority of those who consciously deny it, believe that bad things happen to bad people and good things happen to good people; with one partial exception.

The Exception: When something bad happens to me, I do not deserve it. When something bad happens to anyone else? Yes. They have done something bad to bring on the bad. What goes around comes around and all that. Right? Except for me, of course. I am the exception.

This exception extends to family and friends whom we know well, but still falls under the umbrella of “me” because the closer they are the more their misfortune impacts me, and because I know I am the exception it is logical to conclude that they too are an exception.

So what? It is the way of the world, right? I believe it does not have to be.

Today we are smarter than we have ever been. I know looking around some days, it is difficult to fathom that; but I believe it to be true.

I believe a very large majority of us can understand the logic that follows: if I am the exception because I am me, and if everyone has this concept of self entrenched within their being, then everyone is the exception because everyone is me and no one should have bad things happen to them.

The saddest part is that because there are so many powerful, pretentious bullies and abusers, many of their victims are convinced that they do deserve bad things to happen to them and some believe that good things will not or cannot happen to them and they give up.

The most difficult part to overcome though is not the individual bullies; they will come and go. The most difficult part to overcome is the gangs of bullies; like the Republicans and the Democrats, and the theists and the atheists, and the wealthy, and the bureaucrats, and all of the smaller bands of victimizers, formed and found within and around, (and learning from the example of), the larger gangs.

Belief in The Premise (conscious or not) and belief in The Exception is supported by confirmation bias and anecdotal evidence and perpetuated by superficial reasoning and ignorance. And anyone who actively identifies with a gang or band of bullying pretenders, (no matter how desperate the denial), is working to support and perpetuate their belief.

We have to move from superficial reasoning and ignorance to a depth of analysis that will bring us to better understand the necessity of seeing Humanity as One; the necessity of survival. We have to move past our fear. Any active division between us and them justifies a degree of unreasonable and/or unwarranted fear, which in turn justifies further division between us and them. I believe we are smarter than this. I believe we have to be smarter than this.

Our fear is misdirected. We are afraid of them when we should be afraid of us. For those who understand that everyone is me, it is logical to conclude that there is no us and them, there is only me which is in actuality us; all of us. There is no way to divide me. I am one. Yet fear continues to rule.

So what? It is the way of the world, right?

I believe it does not have to be.

Thoughtful Focus: prioritization, then concentration, that (ideally) leads to clarity.

Once I have identified a priority, I have to know that what I am seeing is not reality. Whether simply fuzzy around the edges or skewed and distorted like a reflection from a Funhouse mirror, my perspective is underdeveloped. I must concentrate to clarify.

A priority should not be determined by the degree of urgency. Urgency dramatically skews and distorts reality.

Concentration is not a one hour meeting with an agenda. An agenda, (or any form of bureaucratic administration), stifles depth and creativity.

Consensus is not clarity. Consensus will always include some measure of surrender, some measure of apathy and some measure of going-along-to-get-along.

But without some agreement, how do we ever move forward?

I must have only one priority in any given moment.

There will be some moments in which my priority is to choose a priority.

And there will be some moments in which my priority is to act on a chosen priority.

Unfortunately, by choosing one priority, (such as work, for example), other priorities are often dictated; chosen by another's sense of urgency, perhaps decided by upper-echelon consensus, possibly in a meeting, likely governed by an agenda, precedent, policy and procedure, and handed down from on high to further entrench a skewed and distorted reality.

But without some agreement, how do we ever move forward?

When a given circumstance dictates priorities, I may have no choice but to consent. This depends upon other priorities.

The challenge then, really lies in the process of prioritization. I believe concentration is an individual skill that can be learned, but because concentration is frequently short-circuited by one's chosen and/or underlying priority I believe prioritization is the key to thoughtful focus. As an example, if my underlying priority is comfort and reduced effort, then my chosen priority will be different than if my underlying priority is to do Good for the sake of the future. There are many underlying priorities that are not consciously or publicly acknowledged; particularly those involving the self and ego. We couch our priorities and actions in compassionate rhetoric that is founded within a sense of reality that is skewed and distorted. And this perpetuates and justifies a superficial sense of urgency, bureaucratic administration and consensus.

The process of prioritization then must include an in-depth examination of one's underlying priorities, and the realization that (like a chosen priority) these too change with circumstance in the moment. This may sound very complex and cumbersome, and it can be. But it can also aid in productivity and flow. For example, if my overarching underlying priority is to Save the World, within each and every moment I can (consciously or not) know if my actions are consistent with my priority. Even within a small scale circumstance, (I can imagine my actions placed upon a larger scale world stage), and I can know if I am doing the right thing. I can better see the moment in which a battle becomes win-able; or a lost cause. I can better appreciate those selfish moments that I may prioritize as necessary for personal well-being and strength to fight another day. I can more productively acknowledge personal mistakes, misjudgements and miscalculations; and I can better learn from them and move on.

Once I believe I have determined underlying priorities, I have to (again) know that what I am seeing is not reality. Whether simply fuzzy around the edges or skewed and distorted like a reflection from a Funhouse mirror, my perspective is underdeveloped. I must concentrate to clarify. I want to believe my sense of reality is merely fuzzy around the edges and not dramatically distorted; and to move forward, I must, in some moments, believe this. And I must, in some moments, act on what I perceive as the result of my thoughtful focus.

I will know if my actions are consistent. And I must find a way to move past the profound sadness that engulfs me when a circumstance appears to demand surrender and I feel that my actions were for little or naught. And this is really what this week's written thought is all about.

I lost a battle and now I am moving on. To see the smug satisfaction of the victors, makes me angry. This will (mostly) go away. What will not lessen is the new layer of certainty and righteousness added to the already widespread fortress of consensus ignorance. What will not change is the damage already inflicted and the pain already suffered. What will not be easily overcome is the trajectory toward more damage and more pain.

As I consider the significance of this circumstance and the reaction of those within it, I realize my fuzzy edges may include a misinterpretation. What I am seeing as smug satisfaction may in actuality be misplaced anger; which in turn may indicate (dare I hope…) progress? Possibly. The wheels often move more slowly than what I would like. I believe the wheels often move more slowly than what is becoming necessary for survival. But in this circumstance I know my actions were consistent with my chosen and underlying priorities, at least to the point of surrender.

Within the circumstance I believed that I ultimately gave in and up because I had become a distraction. Along the way I was cast out and made to feel unwelcome. In my role as pariah I felt I had no choice but to quit the battle and move on. But in hindsight I am asking myself if I gave up too easily? Did I tuck my tail and run because my poor little feelings were hurt? Or was I simply coerced and manipulated into the inevitable? Had I fulfilled my role in this small scale drama and was it really time to move along? I don't know. Objectively, I believe this circumstance is a nice case study for the impact of thoughtful focus and/or the lack of thoughtful focus. As I move beyond my poor little feelings, I realize again the personal benefit of my weekly written thought.

And perhaps one day, with luck long after I am able to influence or be influenced with or by ego, others will consider my weekly written thoughtful focus and apply it to their efforts to Save the World. A boy can dream...

What is there to learn from the unlikeliest of success stories? What depth of understanding can I absorb from a (before-now) impossible comeback?

Never give up?

I am confident this is a piece, but I practice that daily when I get out of bed. Obviously, (though necessary), the effort is not the whole story.

No whining?

To move past the past, no matter how unfair, I believe is another important element. Learn from the mistakes; learn from the adversity; then move on. This does not excuse injustice, but the past should only be drawn upon for the lessons to be learned.

Take control of the narrative?

I believe this is a necessary foundation for faith, and of late I am coming to believe that faith is absolutely necessary for success; so yes, another critical component.

Looking more closely at these factors:

• Faith requires individual commitment and individual sincerity.
• To practice faith is to struggle with injustice and to bring yourself to tears within your uncertainty and doubts and to come out the other side with a new depth of understanding and then to do it again tomorrow.
• Consensus interpretation of the past weakens faith.
• Weakened faith distorts effort.
• Interpretation and misinterpretation of the past directs effort.
• Effort is accomplished in the moment.
• Active, focused, sincere and interdependent individual effort strengthens faith.
• Faith alone is either consensus interpretation or wishful thinking.
• Effort alone creates a bullying bureaucracy and maintains status quo.
• Effort and faith together strengthen the future by perpetuating the moment.
• Effort and faith together see all possible futures.
• The execution of effort and faith together foretell the future.
• What seems impossible today, may not be so tomorrow

For my performance to maintain its upward trajectory, I eventually come to a point where I have to trust someone to do the right thing. Granted, “the right thing” is not necessarily the “Right” thing; it is typically that thing that allows me the continued freedom to choose and implement my process. My question becomes, if (by all accounts) my performance is trending upward based on my process thus far, why would we choose to thwart perceived progress? The simple answer appears (to me) to be ego. The given answer, in recent experience, has been:

• “We can't afford it.”
• “We've never done it that way.”
• “We need a strong consensus before we change process.”
• “That is beyond the scope of your job responsibilities.”
• “It is better to be nice than truthful.”
• “The politics prohibit us from changing course.”
• “We need to slow down.”
• “To maintain confidentiality we cannot tell you why we are choosing to disregard your efforts and progress.”

I am not hearing:

• “Your process is inferior to our current process or another alternative process.”

And, I found this answer reading between all the lines:

• “We cannot follow your lead because you are old and disabled. Stay in your Lane.”

The powers-that-be have done a very good job of maintaining deniability on the “old and disabled” connection, but they have also very definitively put me back in my place, halting perceived progress. So (for me) it is a short leap because it is my age and (more specifically) my disability that initially knocked me back into this place. But this is also the current way of the world; so, enough whining.

Taken individually, some and perhaps many of these answers I have received appear credible. What I want to focus on this week is, “how do I continue an upward trajectory in the face of ego and in the way of the way of the world?” It is a process. My interest is in improvement; an increase in efficiency and productivity with an emphasis on justice. I am not looking to win a Nobel Prize for anything. I simply want to see progress. And I ultimately maintain that if by all accounts my process is moving us forward, and for your varying reasons you stop me, how will we ever know how far we may have gone?

So again, how do I maintain momentum and trajectory?

In hindsight, to this point, going back my entire adult working life, (more than 40 years), I have always trended upward until stopped, then moved to a new circumstance in which due to inexperience and a learning curve I begin a new upward trajectory until…

Wash, Rinse, Repeat. I believe that in any new work experience, all of us process the wash cycle, but then many of us become stuck in that pause or stoppage between wash and rinse, and to maintain appearances we simply re-wash as is necessary. By pushing on to rinse, I am ejected or rejected and forced to repeat in a new machine. I have found I can only maintain appearances by continuing to re-wash for so long before I am compelled to insist upon a rinse cycle.

Is there another way?

As a job-seeker I typically do not have the upper hand. I cannot very well turn the interview upside-down, asking pointed questions and requiring references so I may talk to former employees; though this would be fair. Even the proverbial “Do you have any questions for us?” interview question establishes the divisive (and even adversarial) us/them relationship that leaves me daunted and clearly on the outside looking in. No matter how objectively I am able to ask how they may handle a circumstance in which an employee surpasses expectations and proves worth / value beyond assigned responsibilities, I don't believe (from my side of the divide) I could convince them that my sincere interest was in process improvement to objectively increase efficiency and productivity and to pursue justice. I believe they would see it as the beginnings of an attempted coup.

Wash, Rinse, Repeat…

To Wash is to (at least) minimally fulfill the inherent responsibilities of the job.

To Rinse is to step back, assess, analyze and rework the process for the sake of a better outcome. (And it is in this Rinse cycle where an individual will ultimately need to reach beyond the realm of their specific job responsibilities to maintain momentum and trajectory.)

To Repeat is to have failed.

Perhaps the challenge is not in moving past egos. Perhaps the challenge is in convincing egos that good enough is not good enough and encouraging them to take some calculated risks that may result in (yes, a potentially deeper downside, but also) a potentially greater upside.

This week I am watching the Stanley Cup Finals. Throughout each game I do not see either coach, (one with an interim tag still on his title), reaching for a phone to consult with the General Manager before a line change; or pulling out his laptop to email fans for permission to set new precedent; or even gathering players around for a strong consensus supporting each and every decision he must make. What I see are two coaches taking calculated risks because they understand what is at stake: Epic Fail vs. Lord Stanley's Cup. Yes, many and probably most coaches did calculate the risks throughout their seasons and found downside, but (if they were paying attention) they learned more valuable lessons than those coaches afraid of failure.

I am about to run headlong into a cliché or two. I want to quote some Babe Ruth strikeout statistics; but I won't. I don't believe the Babe can help me to maintain momentum and trajectory. I get angry with failure in the same way that I agonize over injustice. This existential angst forces me to see a greater depth of reality. And perhaps continued effort to expose these depths to those afraid of failure is my best chance for maintaining upward trajectory. Perhaps it is the ego that clouds Vision and (in some cases) prevents one from even looking down into the depths. So perhaps the best way for me to maintain momentum and trajectory is to keep after it and learn the lessons.

As I think this through, even when I successfully complete a rinse cycle, I am still destined to repeat. Until I find Perfection, it is still failure.

I will not find Perfection.

Perhaps the point is the learning and not the machine.

And perhaps it is better to fail, again and again and again, than it is to spend a lifetime in the wash cycle.

I just ran headlong into a cliché.

But I suppose a cliché is a cliché for a reason.